A Study of Cervical Intraepithelial Neoplasia in Pregnancy

Objective

To find the incidence of human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN) in pregnant women and compare Pap smear with the HPV DNA test in detecting HPV infection.

Materials and Methods

Hundred antenatal women, irrespective of gestational age, were enrolled as subjects in this prospective pilot study for blood investigations, wet mount examination of cervical discharge, Pap smear, and high-risk HPV DNA detection of cervical scrape by PCR. Women showing abnormality in Pap smear and/or those who were high-risk HPV DNA positive were subjected to colposcopy.

Results

The incidence of HPV-positive pregnant women was 18 %. Koilocytosis on Pap smear was observed in six women. Three high-risk HPV DNA-positive women showed changes consistent with CIN 1 on colposcopy.

Conclusions

The HPV DNA test is the most sensitive and reliable in detecting HPV infection as compared to Pap smear, but considering the cost of PCR, Pap smear screening of all antenatal women was recommended.     

Interest of Human Papillomavirus DNA quantification and genotyping in paired cervical and urine samples to detect cervical lesions

Background

Cervical cancer is caused by persistent infection with high-risk human papillomavirus (HR-HPV). Conventional human papillomavirus (HPV) testing requires cervical sampling. However, vaginal and urine self-sampling methods are more acceptable for patients and result in increased participation when they are available in screening programs. In this context, we have developed a non-invasive screening method via the detection of HPV DNA in urine samples.

Purpose

To compare HPV viral loads and genotypes in paired cervical and urine samples, and to assess correlation between virological and cytological results in women seeking gynecological consultation.

Methods

Paired urine and cervical specimens were collected and analyzed from 230 of 245 women participating in the previously described prospective PapU study. HPV DNA detection and quantification were performed using a real-time PCR method with short fragment PCR primers. Genotyping was carried out using the INNO-LiPA HPV genotyping assay.

Results

The prevalence of HPV in the 230 paired urine and cervical smear samples was 42 and 49 %, respectively. Overall agreement for HPV positivity and negativity between the paired samples was 90 % (κ = 0.80). High HPV viral load in both cervical and urine samples was associated with cytological abnormalities. HPV-positive women were mostly infected with HR-HPV types. The agreement between high- and low-risk HPV (LR-HPV) detection in both samples was 97 % (κ = 0.95 for HR-HPV and κ = 0.97 for LR-HPV).

Conclusions

High concordance rates for HPV-DNA quantification and high/low-risk HPV genotyping in paired urine/cervical samples suggest that urinary HPV DNA testing could be useful for cervical lesion screening.     

Prevalence of HPV infection and genotypes in women with normal cervical cytology in the state of Paraná, Brazil

Objective

We investigated the prevalence of the human Papillomavirus (HPV) and its genotypes in women with normal cervical cytology in the state of Paraná, Brazil, and also epidemiological characteristics.

Methods

The enrolled patients were seen at six primary health-care units in Pai?andú City, Paraná. Through polymerase chain reaction (PCR) and PCR–RFLP (restriction fragment length polymorphism) techniques, 40 HPV genotypes were found, including 15 high risk, 3 undetermined risk and 22 low risk. Socio-demographic characteristics and sexual behavior were also recorded by interviews based on a structured questionnaire completed at the time of enrollment.

Results

Among 418 patients examined, HPV was detected in 6.7?%, mainly in women aged <25?years. The overall prevalence of high-risk, low-risk and undetermined-risk HPV types was 42.9, 45.7, and 11.7?%, respectively. HPV-16 was the most common type detected (14.3?%), followed by types 66 (11.4?%) and 31 and 70 (8.6?% each). Detection of HPV DNA was positively associated with the number of sexual partners within the previous 12?months (p?Conclusion When considering the lack of studies in Paraná on women with normal cytology, the results of this study will improve estimates of HPV DNA populations, and provide baseline values against which the impact of vaccination can be assessed in the future.     

Coexisting anal human papilloma virus infection in heterosexual women with cervical HPV infection

Aim

To evaluate the prevalence of coexisting anal human papillomavirus (HPV) infection and concordance of HPV types in women with cervical HPV infection and to investigate the possible predictors for anal HPV infection.

Methods

Study group was composed of women referred with documented cervical HPV infection. All patients had undergone anal HPV DNA testing.

Results

One hundred and six patients presenting with cervical HPV infection were eligible for the study. Overall, 24 and 20 distinct HPV genotypes were detected from cervical and anal specimens, respectively. We observed a considerably high prevalence (51.9 %) of coexisting anal HPV infection in our study group. A majority of the women who were found to have anal HPV infection were infected with oncogenic or probable oncogenic types (64.6 %). There were 20.0 and 58.3 % rate of total and partial concordance between the two sites, respectively. We found that no demographic parameter but history of anal intercourse was related with the risk of anal HPV infection.

Conclusion(s)

Women with cervical HPV infection have a considerable risk for coexisting anal HPV infection. Concordance of HPV types infecting the cervix and anal canal is relatively high. There is no strong predictor for anal HPV infection in this population.     

Cofactors in human papillomavirus infection and cervical carcinogenesis

Objective

This study aimed to identify the effect of various risk factors as the promoters of HPV infection, and to identify which HPV-positive women may have an increased risk of developing cervical cancer.

Methods

Smear preparations were examined and classified according to the Bethesda system. HPV-DNA detection and genotyping was carried out using polymerase chain reaction combined with reverse hybridization line-probe assays. Age, smoking habit, age at first sexual intercourse, number of sexual partners, number of term births, contraceptive method, progesterone therapy, history of sexually transmitted diseases, history or existence of warts and existence of cervical infection were recorded.

Results

642 women (96 women with abnormal cervical cytology and 546 women with normal cytology) provided cervical samples. Smoking habit, number of sexual partners, number of term births, history of sexually transmitted diseases, history or existence of warts and existence of cervical infection were identified as the promoters of HPV infection. History of sexually transmitted diseases, history or existence of warts and existence of cervical infection were identified as cofactors affecting progression from HPV infection to cervical cancer. Neither of contraceptive methods studied was related to HPV infection or coexistence with malign transformation to cervical cancer.

Conclusion

Information gathered from this study could be used to prioritize limited screening and treatment services to woman who have specific characteristics that may put them at an increased risk of HPV infection. Additionally, by identifying which women have a higher risk of cervical cancer; it may be possible to reduce the number of unnecessary colposcopies.     

Triaging Pap cytology negative, HPV positive cervical cancer screening results with p16/Ki-67 Dual-stained cytology

Objective

Testing for human papillomavirus (HPV) has been shown to increase the sensitivity and negative predictive value for detection of high-grade cervical intraepithelial neoplasia (CIN2+), either when used in conjunction with Pap cytology testing or alone. However, there is no satisfying clinical management algorithm for women testing Pap negative/HPV positive. We therefore evaluated the clinical utility of a novel dual biomarker-based approach (p16/Ki-67 Dual-stained cytology) for the identification of CIN2+ in women with Pap negative/HPV positive screening results, without the need to refer all women to immediate colposcopy.

Methods

All women aged ≥ 30 enrolled during 2007/2008 into a regional prospective Pap/HPV co-testing screening pilot project and tested Pap negative, but positive for HPV (n = 425) were included in the analysis. p16/Ki-67 Dual-stained cytology was performed from residual cellular material available from the liquid-based cytology vial collected during the initial Pap/HPV co-testing screening visit. Results were correlated to the presence of CIN2+ confirmed during preliminary follow-up.

Results

p16/Ki-67 Dual-stained cytology tested positive at baseline in 108 out of 425 (25.4%) Pap negative/HPV positive cases. Sensitivity of Dual-stain testing for the detection of biopsy-confirmed CIN2+ during preliminary follow-up within the group of Pap negative/HPV positive women was 91.9% for CIN2+ (34/37 cases), and 96.4% for CIN3+ (27/28 cases). Specificity was 82.1% for CIN2+ on biopsy, and 76.9% for CIN3+, respectively.

Conclusions

Triaging Pap negative/HPV positive screening test results with p16/Ki-67 Dual-stained cytology may identify women with a high probability of underlying CIN2+ and may efficiently complement HPV-based screening programs to prevent cervical cancer.     

High-risk human papillomavirus among HIV-infected women with normal cervical cytology: a pilot study in Jos, Nigeria

Background

Cervical cancer is strongly linked to high-risk human papillomavirus (HR-HPV) and is typically preceded by cytological abnormalities. Less is known in patients with normal cervical cytology (NCC). We investigated the epidemiology of HR-HPV among HIV-infected women with NCC.

Methodology

We conducted a cross-sectional study between January and June 2011 among HIV-infected women with NCC at an adult HIV clinic in Jos, Nigeria. Cervical sampling and analysis for HR-HPV by hybrid capture (HC2) with signal amplification was done to determine presence of one or more of the following HR-HPV types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 or 68. Epidemiologic factors associated with HR-HPV were determined using bivariate statistics and multivariate logistic regression.

Results

We evaluated 103 HIV-infected women with Pap cytology. The median age of the women was 32 years (range 21–49). Ninety-seven (94.2 %) had NCC. Cervical samples for HR-HPV DNA testing were available from 89/97 (91.8 %) of the HIV-infected women with NCC. Of the 89 women with cervical samples for HR-HPV DNA testing, 40 (44.9 %) had detectable HR-HPV by HC2 giving a HR-HPV prevalence of 44.9 % (95 % CI 33.9–55.5 %). Age < 30 years was associated with HR-HPV (OR 2.69 [95 % CI 1.05–6.91, p = 0.039]) while history of previous abortion showed an inverse association with HR-HPV (OR 0.33[95 % CI 0.15–0.94, p = 0.039]).

Conclusion

The prevalence of HR-HPV is seemingly high among HIV-infected women with NCC in our clinical setting. These data provide support for further investigation of the clinical implications of positive HR-HPV among HIV-infected women with NCC report in cervical cancer prevention programs in Nigeria.     

High prevalence of high-risk human papillomavirus infection among women with Trichomonas vaginalis infection on monolayer cytology

Objective

To evaluate the risk of high-risk human papillomavirus (HPV) infection in women with Trichomonas vaginalis infection, and the reason remains unclear.

Methods

A total of 40,000 liquid-based cytology specimens were tested from 2005 to 2008. Among these, high-risk HPV testing using the hybrid capture II assay was performed in positive cases of T. vaginalis according to the age of patients (<30 years old, between 30 and 50 years old, more than 50 years old). As controls, HPV detection was also performed in 450 normal smears.

Results

T. vaginalis was found in 80 cases (0.2%). From these 80 cases, 57 were available for HPV testing (8 patients <30 years old, 42 patients between 30 and 50 years old and 7 patients more than 50 years old). As controls, high-risk HPV was tested in 150 patients with normal cytology for each of these three age categories. High-risk HPV was significantly more frequently detected in women with T. vaginalis than in women with normal smear irrespective of the categories of age (P < 0.01).

Conclusion

For the first time, we demonstrated a significant prevalence of high-risk HPV in women with cytological proved T. vaginalis infection independent of the age ranges. Our data suggest a potential association between these two infectious agents by the way of a sexual intercourse and probably by a biochemical or immunological reasons.     

Baseline characteristics and prevalence of HPV 6, 11, 16, 18 in young German women participating in phase III clinical trials of a quadrivalent HPV (6/11/16/18) vaccine

Introduction

As limited data among German women exist about HPV, Chlamydia trachomatis (CT) and Neisseria gonorrhoeae, we report the prevalence of these genital infections and general baseline demographics of the young German women enrolled in the phase III trials of the quadrivalent HPV vaccine.

Materials and methods

German females (n = 437; 9–23 years) were recruited among 3 international phase 3 studies of an HPV-6/11/16/18 vaccine. We present baseline characteristics, prevalence of HPV-6/11/16/18 and, for women aged 16–23, abnormal cervical cytology and sexually transmitted diseases.

Results

Chlamydia trachomatis and Neisseria gonorrhoeae prevalence was 5 and 0.3%, respectively. Approximately 17% of participants had HPV-6, 11, 16, or 18 DNA or antibodies. All subjects <17 years were naïve to the four vaccine types.

Discussion

The results of the vaccine trials have demonstrated that it is worth administering prophylactic HPV vaccines before sexual debut; however, none of these sexually active German women were positive to all four types and most were positive to only one type. Thus, all women had the potential to benefit from vaccination with a quadrivalent HPV vaccine.     

Distribution of various types of low-risk human papillomavirus according to cervical cytology and histology in northern Chinese women

Objective

To describe the distribution of specific types of low-risk (LR) human papillomavirus (HPV) among a general population of northern Chinese women.

Methods

Between 2007 and 2012, 118 096 women were tested with the HPV Geno-Array Test Kit (HybriBio) at China Medical University’s Shengjing Affiliated Hospital, Shenyang, China. Among these women, 80 418 underwent cervical cytology and colposcopic examination, and 30 961 of these had a cervical biopsy. The prevalence of HPV infection among the women was analyzed according to age, and cytologic and histologic findings.

Results

CP8304 was the most common type of LR-HPV overall, and was most prevalent in the youngest age group. The overall prevalence of LR-HPV (averaged across all types) was 1.7% in women with normal cytology, 8.8% in those with atypical squamous cells of undetermined significance (ASCUS), 8.0% in those with low-grade squamous intraepithelial lesions (LSIL), and 5.8% in those with high-grade squamous intraepithelial lesions (HSIL). LR-HPV alone, without any high-risk (HR)-HPV, was most common among women with ASCUS and cervical intraepithelial neoplasia (CIN) not otherwise specified (CINNOS) together. Co-infections of LR-HPV and HR-HPV were most common among women with LSIL and CIN1.

Conclusion

These data will facilitate modeling of the cost-effectiveness of a prophylactic LR-HPV vaccination in China.     

Triaging HPV-positive women with p16/Ki-67 dual-stained cytology: Results from a sub-study nested into the ATHENA trial

Objectives

In addition to genotyping for HPV16/18, dual-immunostaining for p16/Ki-67 has shown promise as a triage of HPV-positive women. We assessed the performance of p16/Ki-67 dual-stained cytology for triaging HPV-positive women undergoing primary HPV screening.

Primary high-risk HPV screening for cervical cancer in post-menopausal women

Objective

The present study was conducted to examine the value of screening for high-risk HPV in post-menopausal women.

Methods

A cohort of post-menopausal women (n = 2113), age range 55-76 years, from Uppsala County, Sweden, were offered testing for both high-risk HPV and a Pap smear in the gynaecological screening during 2008-2010. For the HPV test the cervical smear sample was applied to a filter paper matrix, an indicating FTA elute card and HPV typing performed using a real-time PCR assay. Histological verified CIN2+ lesion was used as an end-point measurement.

Results

High-risk HPV were found in 6.2% (95% CI 5.2-7.3%) of the women (n = 130) and 22% (95% CI 14-32%) (n = 17) of these had CIN2+ lesions based on histology. The Pap smear taken in conjunction with the HPV test was abnormal in 9.7% (95% CI 5.7-16.3%) (n = 12) of HPV positive women. Among HPV positive women with an abnormal Pap smear, the frequency of histology verified CIN2+ lesions was 67% (95% CI 38-86%) (n = 8), as compared to 14% (95% CI 7-24%) (n = 9) in HPV positive women with a normal smear. The prevalence of HPV16 in CIN2+ lesions (29%, 95% CI 22-37%) in post-menopausal women was less than half of previous estimates in pre-menopausal women from this population.

Conclusions

Most histological CIN2+ lesions in post-menopausal women are not recognized by a single Pap smear. A large fraction of pre-invasive cervical cancer cases in post-menopausal women result from infections by HPV types not included in the present vaccine formulas.     

The feasibilities of TruScreen for primary cervical cancer screening: a self-controlled study

Objective

Screening programs based on cytology testing led to the incidence reduction of cervical cancer mortality of about 70–80 % in industrialized countries. However, these favorable results have not been replicated in developing areas. Thus, we aim to evaluate the efficacy of TruScreen (Polartechnics, Sydney, Australia) in detecting of precancerous lesions in comparison with cervical cytology test.

Methods

A total of 181 outpatients were screened by TruScreen using the pathological results as the gold standard. The medical records of cytological smear within 6 weeks were obtained from 169 of these participants. The reliability and yield of TruScreen and cytological smear were assessed. The screening results of TruScreen were compared with those obtained from the conventional smear.

Results

The sensitivities for histologically confirmed cervical intraepithelial neoplasia (CIN) lesions by TruScreen and Pap, were 67.4 % (95 % CI 53.4–81.5) and 87.9 % (95 % CI 76.7–99.0), respectively. The specificities for histologically confirmed CIN lesions by TruScreen and Pap, were 68.1 % (95 % CI 60.3–75.9) and 74.3 % (95 % CI 70.0–81.4), respectively. In contrast to Pap smear, TruScreen was comparatively efficacious in screening of cervical cancer (χ ² = 0.0133, P = 0.9081).

Conclusion

TruScreen is a potential test for initial cervical screening in developing world regions.     

Prevalence and type distribution of high-risk human papillomavirus infections among women in Wufeng County, China

Objective

The aim of this survey was to assess the prevalence and type distribution of oncogenic human papillomavirus (HPV) infections among women in Wufeng County of Hubei province, where the cervical cancer mortality rate is the highest in China Cervical.

Methods

DNA samples were collected from 1,100 women, then screened and quantified by a multi-fluorescent, quantitative real-time PCR assay. The cervical DNA samples were then re-typed by real-time PCR using seven-pair primers of high-risk (HR) HPVs designed to detect types 16, 31, 18/45, 33, 52, 58, and 67.

Results

The overall prevalence of HR HPVs was 11.14?% (95?% CI, 9.74?C13.72?%) in Wufeng County, which was not statistically different between Tu (12.17?%; 95?% CI, 10.03?C12.34?%) and Han nationality (8.95?%; 95?% CI, 3.55?C14.35?%). Among different types of HPV, HPV 16 was the most frequently detected genotype, followed by HPV 52, 58, 18/45, and 31. The most prevalent types of HR HPV in Tu nationality were HPV 16, 52, and 58, and the most prevalent types of HR HPV in Han nationality were HPV 16, 33, and 18/45. The overall prevalence of HPV was highest in the 20?C24?year age group (21.43?%; 95?% CI, 17.56?C25.30?%) and the prevalence of HR HPV was associated with education.

Conclusions

HPV 16, 52, and 58 are common genotypes in Wufeng County, and support the hypothesis that second-generation HPV prophylactic vaccines, including HPV 52 and 58, may offer higher protection for women in China and other areas of Asia. The findings of this study contribute to preventive and screening measures in clinical practice.     

Conventional Pap Smear Screening in HIV Seropositive Women in South India

Objectives

To assess the prevalence of Pap smear abnormalities and to characterize the associated risk factors in HIV seropositive women.

Material and methods

We conducted a cross-sectional study on 252 HIV seropositive women in and around Krishna district, Andhra Pradesh, India by screening them for cervical cytological abnormalities by means of conventional Pap smear screening and the abnormalities reported as per modified Bethesda system.

Results

The prevalence of Pap smear abnormalities in HIV seropositive women was found to be 7.17 % which was a twofold increased risk as compared to the general population. On analysis of the risk factors like younger age for abnormal pap smears, mean CD4 count, duration of disease, and ART/HAART therapy the difference between the two groups of HIV seropositive women with normal pap smears and seropositive women with abnormal pap smears was found to be not statistically significant.

Conclusion

HIV/AIDS is associated with a twofold increased risk for cervical cytological abnormalities, and hence the need for periodic pap smear screening in this high risk group to reduce the global burden of cervical cancer.     

Prevalence and Clinical Utility of Human Papilloma Virus Genotyping in Patients with Cervical Lesions

Objective

Cervical cancer is the commonest cancer among Indian women. High-risk human papilloma virus (HPV) detection holds the potential to be used as a tool to identify women, at risk of subsequent development of cervical cancer. There is a pressing need to identify prevalence of asymptomatic cervical HPV infection in local population. In our study, we explored the prevalence of HPV genotypes and their distribution in women with cervical lesions.

Methods

Scrape specimens were obtained from 100 women (study group) with cervical abnormalities. HPV was detected with amplicor HPV tests, and the individual genotypes in these specimens were identified by Hybribio Genoarray test kit. Fifty specimens were also collected from females with healthy cervix (control group). The present study also aimed to determine the status of HPV prevalence and its association with different sociodemographic factors.

Results

Out of the total number of 100 samples, 10 (10 %) women tested positive for HPV DNA. Among them, HPV 18 was observed in 6, HPV 16 in 2, HPV 52 and HPV 39 in one each. Fifty specimens collected from patients with healthy cervix were not infected with any of the HPV genotype.

Conclusions

Our study generates data of HPV prevalence in patients with cervical lesions visiting tertiary care institute. The data generated will be useful for laying guidelines for mass screening of HPV detection, treatment, and prophylaxis.     

Prognostic significance of the detection of human papilloma virus L1 protein in smears of mild to moderate cervical intraepithelial lesions

Objective

To investigate whether it is possible to use detection of the human papillomavirus (HPV) L1 capsid protein to predict the course of mild or moderate cervical intraepithelial neoplasia (CIN).

Study design

Pap smears from 279 women in whom CIN 1 and CIN 2 had been diagnosed by cytology and histology, who were known to have a high-risk HPV status and had a median follow-up of 25 months, were immunohistochemically stained for the HPV L1 protein. The staining results were correlated with the clinical course of the disease.

Results

HPV L1-positive patients showed regression in 49.1% of cases, stable disease in 41.5%, and progressive disease in 9.4%, whereas HPV L1-negative women had progression in 25.9% of cases (regression 33.3%, stable disease 40.7%; p = 0.001). The effect was clearest in the group under 30 years of age. HPV L1-negative patients experienced progression significantly more often than women with a positive HPV L1 test (odds ratio 3.391).

Conclusions

HPV L1-positivity was found to have prognostic significance in relation to disease progression in women with CIN 1 and CIN 2 and particularly in those less than 30 years of age.     

Evaluación de un nuevo protocolo de cribado de cáncer cervical con citología convencional y test del virus del papiloma humano

Objective

To compare the effectiveness of cervical cancer screening using cytology plus the high risk human papillomavirus (HR-HPV) DNA test in 2011 versus cytology alone in 2010.

Method

Screening was performed in primary care. The target population in the Barbastro sector consisted of 26,936 women (aged 25 to 65 years). The HPV test was performed with hybrid capture (HC2) and the PCR cobas^® system in women between the ages of 30 and 65 years. Women with negative Pap and HPV test results underwent a 5-year recheck as per the latest protocol of Spanish Society of Obstetrics and Gynecology (SEGO, 2010).

Results

A total of 4,770 Pap tests were received in 2010 and 5,241 in 2011 with coverage between 36.8 and 46.8%; 784 HPV tests were carried out in 2010 and 3,560 in 2011, with positive results in 10.58% the first year and in 7.5% the second year. Eighteen new cases of cervical intraepithelial neoplasia grades 2/3 were diagnosed in 2010 and 35 in 2011, along with 3 invasive carcinomas each year (in 2011, 3 microinvasive carcinomas).

Conclusions

The implementation of HPV testing in primary screening for cervical cancer increased the number of pre-invasive lesions detected by 98% in the year of its introduction. Primary Care involvement allows screening for cervical cancer to be performed without additional costs.     

Prevalence and risk factors for human papillomavirus DNA in cervical cytology

Objectives

This study aimed to detect the presence and prevalence of HPV-DNA in the cervical swab samples obtained from patients with cervical cancer, premalignant cervical lesions and benign cervical smear results, and to identify the potential risk factors influencing this prevalence.

Study design

Smear preparations were examined and classified according to the Bethesda system. HPV-DNA detection and genotyping was carried out using polymerase chain reaction combined with reverse hybridization line-probe assays. Age, smoking habit, age at first sexual intercourse, number of sexual partners, number of term births, contraceptive method, progesterone therapy, history of sexually transmitted diseases, history or existence of warts, existence of cervical infection and the history of circumcision of male sexual partners were recorded.

Results

Six hundred and forty-two women (96 women with abnormal cervical cytology and 546 women with normal cytology) provided cervical samples. Multiplex PCR testing revealed that prevalence of HPV-DNA was 38.9% in our study population. HPV-DNA was detected in 78.3% of the women with cervical cancer and 76.9% of the women with HGSIL. Abnormal cervical cytology was observed in 30% of HPV-DNA positive cases and in 5.4% of HPV-DNA negative cases. Our findings also indicate that smoking habit, number of sexual partners, history of sexually transmitted diseases, and abnormal cervical cytology were associated with HPV infection. With respect to parity, there was a decreased risk of HPV infection with the increase in the number of births.

Conclusions

Estimates of the prevalence of HPV infection vary greatly around the world, so the factors that contribute to the rare occurrence of cervical cancer after HPV infection might also differ from country to country. Information gathered from this study could be used to prioritize limited screening and treatment services given to woman who have specific characteristics that may put them at an increased risk of HPV disease.     

Accuracy of dry vaginal self-sampling for detecting high-risk human papillomavirus infection in cervical cancer screening: A cross-sectional study

Objective

Cervical cancer screening coverage remains insufficient in most countries. Testing self-collected samples for high-risk human papillomavirus (HR-HPV) could be an alternative to the Pap smear, but costs, sampling methods and transport issues hamper its wide use. Our objective was to compare diagnostic accuracy of 2 vaginal self-collection methods, a dry swab (vsc-DRY) or swab in liquid medium (vsc-LIQ), for detecting HR-HPV cervical infection assessed by a cervical clinician-collected sample in liquid medium (ccc-LIQ).

Methods

Women 20 to 65 years attending a Pap smear were recruited between September, 2009 and March, 2011. Each sample (3 per woman) underwent HPV DNA testing. Samples were classified as HR-HPV + with detection of at least one HR-HPV or probable HR-HPV type.

Results

Of 734 women included, 722 had complete HPV data. HR-HPV was detected in 20.9% of ccc-LIQ samples. Estimated sensitivity and specificity to detect HR-HPV in vsc-DRY samples were 88.7% and 92.5%, respectively, and in vsc-LIQ samples, 87.4% and 90.9%. Cytology findings were abnormal for 79 women (10.9%): among 27 samples of low-grade squamous intraepithelial lesions, 25 were HR-HPV + in vsc-DRY, vsc-LIQ and ccc-LIQ samples. Among 6 samples of high-grade squamous intraepithelial lesions, all were HR-HPV + in vsc-DRY samples, 1 was HR-HPV − in vsc-LIQ samples and 1 was HR-HPV − in ccc-LIQ samples.

Conclusions

Vaginal self-sampling with a dry swab is accurate to detect HR-HPV infection as compared with cervical clinician-collection and accurate as compared with cytology results. This cheap and easy-to-ship sampling method could be widely used in a cervical cancer screening program.